The idea that the end of AIDS is near has been announced recently in international events on the disease, but it creates a “smokescreen” for governments to hide budget cuts to programs and the shortage of the latest antiretroviral drugs. According to American anthropologist Richard Parker, 60, Full Professor Emeritus at Columbia University, New York, despite real strides in AIDS treatment, huge challenges remain, like the fact that 50% of patients lack access to treatment. The Director and President of the Brazilian Interdisciplinary AIDS Association says that even Brazil’s successful HIV/AIDS program has begun to lose strength, with difficulties in incorporating the more expensive drugs, besides logistics problems.

A lot of speeches are announcing that the end of AIDS is near. Is this real?

RICHARD PARKER – These triumphalist discourses are inspired by real progress, expansion of access to treatment, and the efficacy of new antiretroviral drugs, in addition to the possibility of using them to prevent infection, through post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP).

The problem is that these discourses on the end of AIDS ignore the epidemic’s harsh reality in the majority of the affected countries and communities. Twenty years have passed since the announcement of effective treatments, and despite the efforts, 50% of people still lack access to the medicines. In many countries the drugs are outdated, with important side effects, a phenomenon we could call “second-class access”.

Why all the silence on these issues?

PARKER – Greed on the part of pharmaceutical companies, the prevailing patent system, lack of government commitment and investment, and so on. Despite the progress, there is a widespread lack of commitment to prevention.

At the global level, the number of new HIV infections has not dropped since 2010, because access to prevention has never been guaranteed as a universal right, especially due to the stigma and discrimination surrounding the epidemic.

Since issues like sexuality and drug use are involved, most societies either fail to invest in prevention or they invest in prejudiced and counterproductive ways, without tackling the barriers that make people vulnerable in the first place.

So is ending AIDS by 2030 an unrealistic goal?

PARKER – According to our critical reading, we have a long way to go to end AIDS. And the biggest problem is that jumping the gun on this goal serves as a smokescreen and hides the harsh reality of the epidemic’s persistence in nearly all the countries. It hides the suffering of people that still lack access to treatment. It hides the high mortality rates, even in countries like Brazil with universal access. And it hides the lack of access to prevention.

Does this also impact the future funding of AIDS programs?

PARKER – Nearly all of the donor countries are on the brink of a political tragedy. The funding for health in general and AIDS specifically is clearly going to decrease, both from the donor countries (United States and Europe) and in terms of the planning capacity of the countries most affected by the epidemic.

To the extent that the push from [Donald] Trump and others is to put “America first”, foreign aid for development tends to decrease drastically.

The idea that AIDS is on the verge of ending offers a perfect excuse – so the threat is real for AIDS programs. For the first time since UNAIDS was created, the program is suffering serious threats of budget cuts. In other countries, including Brazil, economic neoliberalism and the emphasis on fiscal adjustments are threatening the programs’ continuity.

Which poor countries are already facing budget cuts?

PARKER – After a decade of increases in funding over the 2000s – due mainly to large-scale initiatives like PEPFAR under the U.S. government and the Global Fund to Fight AIDS, Tuberculosis, and Malaria, encouraged by the United Nations – we are now witnessing what we can call a “scale-down” in support.

PEPFAR had already begun pulling back on support to its priority countries, like Vietnam, South Africa, Tanzania, and others, especially in Africa. And the Global Fund is unable to collect the money pledged by donor countries.

While the pharmaceutical industry offers discounts to extremely poor countries, it also charges higher prices in middle-income and emerging countries, which have less access to funding through international cooperation.

This hinders the adoption of second and third-generation antiretroviral drugs, which have fewer side effects. This problem affects Brazil directly. Brazil has never received foreign aid to cover the cost of medicines, but over the years it has received funding to support other components of its comprehensive HIV/AIDS program. However, the sources of international support no longer exist. And there is a direct impact on the country’s capacity to maintain the quality of other services that are part of an adequate response to the epidemic.

Is there a risk of resurgence of the epidemic in Brazil?

PARKER – Over the course of the 1990s and 2000s, Brazil built an extremely successful response to the epidemic. Unfortunately, in the early 2010s, this commitment has become less evident. The government has been unable to resist pressure from conservative sectors and has abandoned prevention campaigns and the fight against stigma and discrimination.

Many civil society organizations have closed down. And even the successful program for access to medicines has begun to lose force, with difficulty in incorporating new, more expensive drugs, besides growing logistics problems in the supply of medicines.

These setbacks coexist with other actions that can be rated positively. Rapid testing may be a step forward, but we need to assess its consequences. The availability of PEP is definitely positive, but it has not been publicized, which may limit its efficacy. The Ministry of Health has announced the availability of PrEP, but has not actually supplied it. Apparently PrEP is finally going to become a reality this year, but we have to wait and see.

Is there omission on the part of government programs in relation to the concentration of HIV infection among young gay men and other populations?

PARKER – There is definitely a historical omission in relation to the concentration of HIV infection among young gay men and other marginalized populations. We can see this clearly in the series of cases of censorship against prevention campaigns for these populations, starting in 2010.

In the last year, the campaigns improved, and there was at least one attempt to reclaim the push for barriers against stigma and discrimination. Brazil’s polarized political context, with a tremendous lack of leadership on social issues, has generally hindered this process.

ABOUT RICHARD PARKER

Age: 60

Work: Director and President of the Brazilian Interdisciplinary AIDS Association (ABIA), Full Professor Emeritus and member of the Committee on Global Thought, Columbia University (New York); author of more than 250 scientific publications.